Illinois 2025-2026 Regular Session

Illinois House Bill HB2910 Compare Versions

Only one version of the bill is available at this time.

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1	1	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB2910 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-5.2 Provides that, if and only if House Bill 4907 of the 103rd General Assembly becomes law, then the Medical Assistance Article of the Illinois Public Aid Code is amended by adding new provisions concerning PDPM Strive staffing ratio calculations for nursing facilities. Provides that, beginning January 1, 2026, the staffing percentage used in the calculation of the per diem staffing add-on shall be its PDPM STRIVE Staffing Ratio. Sets forth how to calculate a nursing facility's PDPM STRIVE Staffing Ratio, PDPM STRIVE Staffing Target, Illinois Adjusted Facility Case-Mix Hours Per Resident Per Day, and STRIVE staffing fee schedule. Effective immediately or on the date House Bill 4907 of the 103rd General Assembly takes effect, whichever is later. LRB104 09542 KTG 19605 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB2910 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED: 305 ILCS 5/5-5.2 305 ILCS 5/5-5.2 Provides that, if and only if House Bill 4907 of the 103rd General Assembly becomes law, then the Medical Assistance Article of the Illinois Public Aid Code is amended by adding new provisions concerning PDPM Strive staffing ratio calculations for nursing facilities. Provides that, beginning January 1, 2026, the staffing percentage used in the calculation of the per diem staffing add-on shall be its PDPM STRIVE Staffing Ratio. Sets forth how to calculate a nursing facility's PDPM STRIVE Staffing Ratio, PDPM STRIVE Staffing Target, Illinois Adjusted Facility Case-Mix Hours Per Resident Per Day, and STRIVE staffing fee schedule. Effective immediately or on the date House Bill 4907 of the 103rd General Assembly takes effect, whichever is later. LRB104 09542 KTG 19605 b LRB104 09542 KTG 19605 b A BILL FOR
2	2	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB2910 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED:
3	3	305 ILCS 5/5-5.2 305 ILCS 5/5-5.2
4	4	305 ILCS 5/5-5.2
5	5	Provides that, if and only if House Bill 4907 of the 103rd General Assembly becomes law, then the Medical Assistance Article of the Illinois Public Aid Code is amended by adding new provisions concerning PDPM Strive staffing ratio calculations for nursing facilities. Provides that, beginning January 1, 2026, the staffing percentage used in the calculation of the per diem staffing add-on shall be its PDPM STRIVE Staffing Ratio. Sets forth how to calculate a nursing facility's PDPM STRIVE Staffing Ratio, PDPM STRIVE Staffing Target, Illinois Adjusted Facility Case-Mix Hours Per Resident Per Day, and STRIVE staffing fee schedule. Effective immediately or on the date House Bill 4907 of the 103rd General Assembly takes effect, whichever is later.
6	6	LRB104 09542 KTG 19605 b LRB104 09542 KTG 19605 b
7	7	LRB104 09542 KTG 19605 b
8	8	A BILL FOR
9	9	HB2910LRB104 09542 KTG 19605 b HB2910 LRB104 09542 KTG 19605 b
10	10	HB2910 LRB104 09542 KTG 19605 b
11	11	1 AN ACT concerning public aid.
12	12	2 Be it enacted by the People of the State of Illinois,
13	13	3 represented in the General Assembly:
14	14	4 Section 5. If and only if House Bill 4907 of the 103rd
15	15	5 General Assembly becomes law, then the Illinois Public Aid
16	16	6 Code is amended by changing Section 5-5.2 as follows:
17	17	7 (305 ILCS 5/5-5.2)
18	18	8 Sec. 5-5.2. Payment.
19	19	9 (a) All nursing facilities that are grouped pursuant to
20	20	10 Section 5-5.1 of this Act shall receive the same rate of
21	21	11 payment for similar services.
22	22	12 (b) It shall be a matter of State policy that the Illinois
23	23	13 Department shall utilize a uniform billing cycle throughout
24	24	14 the State for the long-term care providers.
25	25	15 (c) (Blank).
26	26	16 (c-1) Notwithstanding any other provisions of this Code,
27	27	17 the methodologies for reimbursement of nursing services as
28	28	18 provided under this Article shall no longer be applicable for
29	29	19 bills payable for nursing services rendered on or after a new
30	30	20 reimbursement system based on the Patient Driven Payment Model
31	31	21 (PDPM) has been fully operationalized, which shall take effect
32	32	22 for services provided on or after the implementation of the
33	33	23 PDPM reimbursement system begins. For the purposes of Public
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37	37	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB2910 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED:
38	38	305 ILCS 5/5-5.2 305 ILCS 5/5-5.2
39	39	305 ILCS 5/5-5.2
40	40	Provides that, if and only if House Bill 4907 of the 103rd General Assembly becomes law, then the Medical Assistance Article of the Illinois Public Aid Code is amended by adding new provisions concerning PDPM Strive staffing ratio calculations for nursing facilities. Provides that, beginning January 1, 2026, the staffing percentage used in the calculation of the per diem staffing add-on shall be its PDPM STRIVE Staffing Ratio. Sets forth how to calculate a nursing facility's PDPM STRIVE Staffing Ratio, PDPM STRIVE Staffing Target, Illinois Adjusted Facility Case-Mix Hours Per Resident Per Day, and STRIVE staffing fee schedule. Effective immediately or on the date House Bill 4907 of the 103rd General Assembly takes effect, whichever is later.
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43	43	A BILL FOR
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49	49	305 ILCS 5/5-5.2
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68	68	1 Act 102-1035, the implementation date of the PDPM
69	69	2 reimbursement system and all related provisions shall be July
70	70	3 1, 2022 if the following conditions are met: (i) the Centers
71	71	4 for Medicare and Medicaid Services has approved corresponding
72	72	5 changes in the reimbursement system and bed assessment; and
73	73	6 (ii) the Department has filed rules to implement these changes
74	74	7 no later than June 1, 2022. Failure of the Department to file
75	75	8 rules to implement the changes provided in Public Act 102-1035
76	76	9 no later than June 1, 2022 shall result in the implementation
77	77	10 date being delayed to October 1, 2022.
78	78	11 (d) The new nursing services reimbursement methodology
79	79	12 utilizing the Patient Driven Payment Model, which shall be
80	80	13 referred to as the PDPM reimbursement system, taking effect
81	81	14 July 1, 2022, upon federal approval by the Centers for
82	82	15 Medicare and Medicaid Services, shall be based on the
83	83	16 following:
84	84	17 (1) The methodology shall be resident-centered,
85	85	18 facility-specific, cost-based, and based on guidance from
86	86	19 the Centers for Medicare and Medicaid Services.
87	87	20 (2) Costs shall be annually rebased and case mix index
88	88	21 quarterly updated. The nursing services methodology will
89	89	22 be assigned to the Medicaid enrolled residents on record
90	90	23 as of 30 days prior to the beginning of the rate period in
91	91	24 the Department's Medicaid Management Information System
92	92	25 (MMIS) as present on the last day of the second quarter
93	93	26 preceding the rate period based upon the Assessment
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104	104	1 Reference Date of the Minimum Data Set (MDS).
105	105	2 (3) Regional wage adjustors based on the Health
106	106	3 Service Areas (HSA) groupings and adjusters in effect on
107	107	4 April 30, 2012 shall be included, except no adjuster shall
108	108	5 be lower than 1.06.
109	109	6 (4) PDPM nursing case mix indices in effect on March
110	110	7 1, 2022 shall be assigned to each resident class at no less
111	111	8 than 0.7858 of the Centers for Medicare and Medicaid
112	112	9 Services PDPM unadjusted case mix values, in effect on
113	113	10 March 1, 2022.
114	114	11 (5) The pool of funds available for distribution by
115	115	12 case mix and the base facility rate shall be determined
116	116	13 using the formula contained in subsection (d-1).
117	117	14 (6) The Department shall establish a variable per diem
118	118	15 staffing add-on in accordance with the most recent
119	119	16 available federal staffing report, currently the Payroll
120	120	17 Based Journal, for the same period of time, and if
121	121	18 applicable adjusted for acuity using the same quarter's
122	122	19 MDS. The Department shall rely on Payroll Based Journals
123	123	20 provided to the Department of Public Health to make a
124	124	21 determination of non-submission. If the Department is
125	125	22 notified by a facility of missing or inaccurate Payroll
126	126	23 Based Journal data or an incorrect calculation of
127	127	24 staffing, the Department must make a correction as soon as
128	128	25 the error is verified for the applicable quarter.
129	129	26 Beginning October 1, 2024, the staffing percentage
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140	140	1 used in the calculation of the per diem staffing add-on
141	141	2 shall be its PDPM STRIVE Staffing Ratio which equals: its
142	142	3 Reported Total Nurse Staffing Hours Per Resident Per Day
143	143	4 as published in the most recent federal staffing report
144	144	5 (the Provider Information File), divided by the facility's
145	145	6 PDPM STRIVE Staffing Target. Each facility's PDPM STRIVE
146	146	7 Staffing Target is equal to .82 times the facility's
147	147	8 Illinois Adjusted Facility Case-Mix Hours Per Resident Per
148	148	9 Day. A facility's Illinois Adjusted Facility Case Mix
149	149	10 Hours Per Resident Per Day is equal to its Case-Mix Total
150	150	11 Nurse Staffing Hours Per Resident Per Day (as published in
151	151	12 the most recent federal Provider Information file) times
152	152	13 3.662 (which reflects the national resident days-weighted
153	153	14 mean Reported Total Nurse Staffing Hours Per Resident Per
154	154	15 Day as calculated using the January 2024 federal Provider
155	155	16 Information Files), divided by the national resident
156	156	17 days-weighted mean Reported Total Nurse Staffing Hours Per
157	157	18 Resident Per Day calculated using the most recent State US
158	158	19 Averages file.
159	159	20 Beginning January 1, 2025, the staffing percentage
160	160	21 used in the calculation of the per diem staffing add-on
161	161	22 shall be its PDPM STRIVE Staffing Ratio which equals: its
162	162	23 Reported Total Nurse Staffing Hours Per Resident Per Day
163	163	24 as published in the most recent federal staffing report
164	164	25 (the Provider Information File), divided by the facility's
165	165	26 PDPM STRIVE Staffing Target. Each facility's PDPM STRIVE
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176	176	1 Staffing Target is equal to .7122 times the facility's
177	177	2 Illinois Adjusted Facility Case-Mix Hours Per Resident Per
178	178	3 Day. A facility's Illinois Adjusted Facility Case Mix
179	179	4 Hours Per Resident Per Day is equal to its Case-Mix Total
180	180	5 Nurse Staffing Hours Per Resident Per Day (as published in
181	181	6 the most recent federal staffing report Provider
182	182	7 Information file) times 3.79 (which is the Reported Total
183	183	8 Nurse Staffing Hours Per Resident Per Day for the Nation
184	184	9 as reported in the January 2024 State US Averages file),
185	185	10 divided by the Reported Total Nurse Staffing Hours Per
186	186	11 Resident Per Day for the Nation as reported in the most
187	187	12 recent State US Averages file.
188	188	13 Beginning January 1, 2026, the staffing percentage
189	189	14 used in the calculation of the per diem staffing add-on
190	190	15 shall be its PDPM STRIVE Staffing Ratio which equals: its
191	191	16 Reported Total Nurse Staffing Hours Per Resident Per Day
192	192	17 as published in the most recent federal staffing report
193	193	18 (the Provider Information File), divided by the facility's
194	194	19 PDPM STRIVE Staffing Target. Each facility's PDPM STRIVE
195	195	20 Staffing Target is equal to .7122 times the facility's
196	196	21 Illinois Adjusted Facility Case-Mix Hours Per Resident Per
197	197	22 Day. A facility's Illinois Adjusted Facility Case-Mix
198	198	23 Hours Per Resident Per Day is equal to its Nursing
199	199	24 Case-Mix (as published in the most recent federal staffing
200	200	25 report Provider Information File) divided by 1.36671 and
201	201	26 then multiplied by 3.79 (which is the Reported Total Nurse
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212	212	1 Staffing Hours Per Resident Per Day for the Nation as
213	213	2 reported in the January 2024 State US Averages file),
214	214	3 divided by the Reported Total Nurse Staffing Hours Per
215	215	4 Resident Per Day for the Nation as reported in the most
216	216	5 recent State US Averages file.
217	217	6 (6.5) Beginning July 1, 2024, the paid per diem
218	218	7 staffing add-on shall be the paid per diem staffing add-on
219	219	8 in effect April 1, 2024. For dates beginning October 1,
220	220	9 2024 and through September 30, 2025, the denominator for
221	221	10 the staffing percentage shall be the lesser of the
222	222	11 facility's PDPM STRIVE Staffing Target and:
223	223	12 (A) For the quarter beginning October 1, 2024, the
224	224	13 sum of 20% of the facility's PDPM STRIVE Staffing
225	225	14 Target and 80% of the facility's Case-Mix Total Nurse
226	226	15 Staffing Hours Per Resident Per Day (as published in
227	227	16 the January 2024 federal staffing report).
228	228	17 (B) For the quarter beginning January 1, 2025, the
229	229	18 sum of 40% of the facility's PDPM STRIVE Staffing
230	230	19 Target and 60% of the facility's Case-Mix Total Nurse
231	231	20 Staffing Hours Per Resident Per Day (as published in
232	232	21 the January 2024 federal staffing report).
233	233	22 (C) For the quarter beginning March 1, 2025, the
234	234	23 sum of 60% of the facility's PDPM STRIVE Staffing
235	235	24 Target and 40% of the facility's Case-Mix Total Nurse
236	236	25 Staffing Hours Per Resident Per Day (as published in
237	237	26 the January 2024 federal staffing report).
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248	248	1 (D) For the quarter beginning July 1, 2025, the
249	249	2 sum of 80% of the facility's PDPM STRIVE Staffing
250	250	3 Target and 20% of the facility's Case-Mix Total Nurse
251	251	4 Staffing Hours Per Resident Per Day (as published in
252	252	5 the January 2024 federal staffing report).
253	253	6 Facilities with at least 70% of the staffing
254	254	7 indicated by the STRIVE study shall be paid a per diem
255	255	8 add-on of $9, increasing by equivalent steps for each
256	256	9 whole percentage point until the facilities reach a per
257	257	10 diem of $16.52. Facilities with at least 80% of the
258	258	11 staffing indicated by the STRIVE study shall be paid a per
259	259	12 diem add-on of $16.52, increasing by equivalent steps for
260	260	13 each whole percentage point until the facilities reach a
261	261	14 per diem add-on of $25.77. Facilities with at least 92% of
262	262	15 the staffing indicated by the STRIVE study shall be paid a
263	263	16 per diem add-on of $25.77, increasing by equivalent steps
264	264	17 for each whole percentage point until the facilities reach
265	265	18 a per diem add-on of $30.98. Facilities with at least 100%
266	266	19 of the staffing indicated by the STRIVE study shall be
267	267	20 paid a per diem add-on of $30.98, increasing by equivalent
268	268	21 steps for each whole percentage point until the facilities
269	269	22 reach a per diem add-on of $36.44. Facilities with at
270	270	23 least 110% of the staffing indicated by the STRIVE study
271	271	24 shall be paid a per diem add-on of $36.44, increasing by
272	272	25 equivalent steps for each whole percentage point until the
273	273	26 facilities reach a per diem add-on of $38.68. Facilities
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284	284	1 with at least 125% or higher of the staffing indicated by
285	285	2 the STRIVE study shall be paid a per diem add-on of $38.68.
286	286	3 No nursing facility's variable staffing per diem add-on
287	287	4 shall be reduced by more than 5% in 2 consecutive
288	288	5 quarters. For the quarters beginning July 1, 2022 and
289	289	6 October 1, 2022, no facility's variable per diem staffing
290	290	7 add-on shall be calculated at a rate lower than 85% of the
291	291	8 staffing indicated by the STRIVE study. No facility below
292	292	9 70% of the staffing indicated by the STRIVE study shall
293	293	10 receive a variable per diem staffing add-on after December
294	294	11 31, 2022. Beginning January 1, 2026, the STRIVE staffing
295	295	12 fee schedule shall be multiplied by the regional wage
296	296	13 adjuster in subsection (d) paragraph (3) of this Section.
297	297	14 (7) For dates of services beginning July 1, 2022, the
298	298	15 PDPM nursing component per diem for each nursing facility
299	299	16 shall be the product of the facility's (i) statewide PDPM
300	300	17 nursing base per diem rate, $92.25, adjusted for the
301	301	18 facility average PDPM case mix index calculated quarterly
302	302	19 and (ii) the regional wage adjuster, and then add the
303	303	20 Medicaid access adjustment as defined in (e-3) of this
304	304	21 Section. Transition rates for services provided between
305	305	22 July 1, 2022 and October 1, 2023 shall be the greater of
306	306	23 the PDPM nursing component per diem or:
307	307	24 (A) for the quarter beginning July 1, 2022, the
308	308	25 RUG-IV nursing component per diem;
309	309	26 (B) for the quarter beginning October 1, 2022, the
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320	320	1 sum of the RUG-IV nursing component per diem
321	321	2 multiplied by 0.80 and the PDPM nursing component per
322	322	3 diem multiplied by 0.20;
323	323	4 (C) for the quarter beginning January 1, 2023, the
324	324	5 sum of the RUG-IV nursing component per diem
325	325	6 multiplied by 0.60 and the PDPM nursing component per
326	326	7 diem multiplied by 0.40;
327	327	8 (D) for the quarter beginning April 1, 2023, the
328	328	9 sum of the RUG-IV nursing component per diem
329	329	10 multiplied by 0.40 and the PDPM nursing component per
330	330	11 diem multiplied by 0.60;
331	331	12 (E) for the quarter beginning July 1, 2023, the
332	332	13 sum of the RUG-IV nursing component per diem
333	333	14 multiplied by 0.20 and the PDPM nursing component per
334	334	15 diem multiplied by 0.80; or
335	335	16 (F) for the quarter beginning October 1, 2023 and
336	336	17 each subsequent quarter, the transition rate shall end
337	337	18 and a nursing facility shall be paid 100% of the PDPM
338	338	19 nursing component per diem.
339	339	20 (d-1) Calculation of base year Statewide RUG-IV nursing
340	340	21 base per diem rate.
341	341	22 (1) Base rate spending pool shall be:
342	342	23 (A) The base year resident days which are
343	343	24 calculated by multiplying the number of Medicaid
344	344	25 residents in each nursing home as indicated in the MDS
345	345	26 data defined in paragraph (4) by 365.
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356	356	1 (B) Each facility's nursing component per diem in
357	357	2 effect on July 1, 2012 shall be multiplied by
358	358	3 subsection (A).
359	359	4 (C) Thirteen million is added to the product of
360	360	5 subparagraph (A) and subparagraph (B) to adjust for
361	361	6 the exclusion of nursing homes defined in paragraph
362	362	7 (5).
363	363	8 (2) For each nursing home with Medicaid residents as
364	364	9 indicated by the MDS data defined in paragraph (4),
365	365	10 weighted days adjusted for case mix and regional wage
366	366	11 adjustment shall be calculated. For each home this
367	367	12 calculation is the product of:
368	368	13 (A) Base year resident days as calculated in
369	369	14 subparagraph (A) of paragraph (1).
370	370	15 (B) The nursing home's regional wage adjustor
371	371	16 based on the Health Service Areas (HSA) groupings and
372	372	17 adjustors in effect on April 30, 2012.
373	373	18 (C) Facility weighted case mix which is the number
374	374	19 of Medicaid residents as indicated by the MDS data
375	375	20 defined in paragraph (4) multiplied by the associated
376	376	21 case weight for the RUG-IV 48 grouper model using
377	377	22 standard RUG-IV procedures for index maximization.
378	378	23 (D) The sum of the products calculated for each
379	379	24 nursing home in subparagraphs (A) through (C) above
380	380	25 shall be the base year case mix, rate adjusted
381	381	26 weighted days.
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392	392	1 (3) The Statewide RUG-IV nursing base per diem rate:
393	393	2 (A) on January 1, 2014 shall be the quotient of the
394	394	3 paragraph (1) divided by the sum calculated under
395	395	4 subparagraph (D) of paragraph (2);
396	396	5 (B) on and after July 1, 2014 and until July 1,
397	397	6 2022, shall be the amount calculated under
398	398	7 subparagraph (A) of this paragraph (3) plus $1.76; and
399	399	8 (C) beginning July 1, 2022 and thereafter, $7
400	400	9 shall be added to the amount calculated under
401	401	10 subparagraph (B) of this paragraph (3) of this
402	402	11 Section.
403	403	12 (4) Minimum Data Set (MDS) comprehensive assessments
404	404	13 for Medicaid residents on the last day of the quarter used
405	405	14 to establish the base rate.
406	406	15 (5) Nursing facilities designated as of July 1, 2012
407	407	16 by the Department as "Institutions for Mental Disease"
408	408	17 shall be excluded from all calculations under this
409	409	18 subsection. The data from these facilities shall not be
410	410	19 used in the computations described in paragraphs (1)
411	411	20 through (4) above to establish the base rate.
412	412	21 (e) Beginning July 1, 2014, the Department shall allocate
413	413	22 funding in the amount up to $10,000,000 for per diem add-ons to
414	414	23 the RUGS methodology for dates of service on and after July 1,
415	415	24 2014:
416	416	25 (1) $0.63 for each resident who scores in I4200
417	417	26 Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
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428	428	1 (2) $2.67 for each resident who scores either a "1" or
429	429	2 "2" in any items S1200A through S1200I and also scores in
430	430	3 RUG groups PA1, PA2, BA1, or BA2.
431	431	4 (e-1) (Blank).
432	432	5 (e-2) For dates of services beginning January 1, 2014 and
433	433	6 ending September 30, 2023, the RUG-IV nursing component per
434	434	7 diem for a nursing home shall be the product of the statewide
435	435	8 RUG-IV nursing base per diem rate, the facility average case
436	436	9 mix index, and the regional wage adjustor. For dates of
437	437	10 service beginning July 1, 2022 and ending September 30, 2023,
438	438	11 the Medicaid access adjustment described in subsection (e-3)
439	439	12 shall be added to the product.
440	440	13 (e-3) A Medicaid Access Adjustment of $4 adjusted for the
441	441	14 facility average PDPM case mix index calculated quarterly
442	442	15 shall be added to the statewide PDPM nursing per diem for all
443	443	16 facilities with annual Medicaid bed days of at least 70% of all
444	444	17 occupied bed days adjusted quarterly. For each new calendar
445	445	18 year and for the 6-month period beginning July 1, 2022, the
446	446	19 percentage of a facility's occupied bed days comprised of
447	447	20 Medicaid bed days shall be determined by the Department
448	448	21 quarterly. For dates of service beginning January 1, 2023, the
449	449	22 Medicaid Access Adjustment shall be increased to $4.75. This
450	450	23 subsection shall be inoperative on and after January 1, 2028.
451	451	24 (e-4) Subject to federal approval, on and after January 1,
452	452	25 2024, the Department shall increase the rate add-on at
453	453	26 paragraph (7) subsection (a) under 89 Ill. Adm. Code 147.335
454	454
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464	464	1 for ventilator services from $208 per day to $481 per day.
465	465	2 Payment is subject to the criteria and requirements under 89
466	466	3 Ill. Adm. Code 147.335.
467	467	4 (f) (Blank).
468	468	5 (g) Notwithstanding any other provision of this Code, on
469	469	6 and after July 1, 2012, for facilities not designated by the
470	470	7 Department of Healthcare and Family Services as "Institutions
471	471	8 for Mental Disease", rates effective May 1, 2011 shall be
472	472	9 adjusted as follows:
473	473	10 (1) (Blank);
474	474	11 (2) (Blank);
475	475	12 (3) Facility rates for the capital and support
476	476	13 components shall be reduced by 1.7%.
477	477	14 (h) Notwithstanding any other provision of this Code, on
478	478	15 and after July 1, 2012, nursing facilities designated by the
479	479	16 Department of Healthcare and Family Services as "Institutions
480	480	17 for Mental Disease" and "Institutions for Mental Disease" that
481	481	18 are facilities licensed under the Specialized Mental Health
482	482	19 Rehabilitation Act of 2013 shall have the nursing,
483	483	20 socio-developmental, capital, and support components of their
484	484	21 reimbursement rate effective May 1, 2011 reduced in total by
485	485	22 2.7%.
486	486	23 (i) On and after July 1, 2014, the reimbursement rates for
487	487	24 the support component of the nursing facility rate for
488	488	25 facilities licensed under the Nursing Home Care Act as skilled
489	489	26 or intermediate care facilities shall be the rate in effect on
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500	500	1 June 30, 2014 increased by 8.17%.
501	501	2 (i-1) Subject to federal approval, on and after January 1,
502	502	3 2024, the reimbursement rates for the support component of the
503	503	4 nursing facility rate for facilities licensed under the
504	504	5 Nursing Home Care Act as skilled or intermediate care
505	505	6 facilities shall be the rate in effect on June 30, 2023
506	506	7 increased by 12%.
507	507	8 (j) Notwithstanding any other provision of law, subject to
508	508	9 federal approval, effective July 1, 2019, sufficient funds
509	509	10 shall be allocated for changes to rates for facilities
510	510	11 licensed under the Nursing Home Care Act as skilled nursing
511	511	12 facilities or intermediate care facilities for dates of
512	512	13 services on and after July 1, 2019: (i) to establish, through
513	513	14 June 30, 2022 a per diem add-on to the direct care per diem
514	514	15 rate not to exceed $70,000,000 annually in the aggregate
515	515	16 taking into account federal matching funds for the purpose of
516	516	17 addressing the facility's unique staffing needs, adjusted
517	517	18 quarterly and distributed by a weighted formula based on
518	518	19 Medicaid bed days on the last day of the second quarter
519	519	20 preceding the quarter for which the rate is being adjusted.
520	520	21 Beginning July 1, 2022, the annual $70,000,000 described in
521	521	22 the preceding sentence shall be dedicated to the variable per
522	522	23 diem add-on for staffing under paragraph (6) of subsection
523	523	24 (d); and (ii) in an amount not to exceed $170,000,000 annually
524	524	25 in the aggregate taking into account federal matching funds to
525	525	26 permit the support component of the nursing facility rate to
526	526
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536	536	1 be updated as follows:
537	537	2 (1) 80%, or $136,000,000, of the funds shall be used
538	538	3 to update each facility's rate in effect on June 30, 2019
539	539	4 using the most recent cost reports on file, which have had
540	540	5 a limited review conducted by the Department of Healthcare
541	541	6 and Family Services and will not hold up enacting the rate
542	542	7 increase, with the Department of Healthcare and Family
543	543	8 Services.
544	544	9 (2) After completing the calculation in paragraph (1),
545	545	10 any facility whose rate is less than the rate in effect on
546	546	11 June 30, 2019 shall have its rate restored to the rate in
547	547	12 effect on June 30, 2019 from the 20% of the funds set
548	548	13 aside.
549	549	14 (3) The remainder of the 20%, or $34,000,000, shall be
550	550	15 used to increase each facility's rate by an equal
551	551	16 percentage.
552	552	17 (k) During the first quarter of State Fiscal Year 2020,
553	553	18 the Department of Healthcare of Family Services must convene a
554	554	19 technical advisory group consisting of members of all trade
555	555	20 associations representing Illinois skilled nursing providers
556	556	21 to discuss changes necessary with federal implementation of
557	557	22 Medicare's Patient-Driven Payment Model. Implementation of
558	558	23 Medicare's Patient-Driven Payment Model shall, by September 1,
559	559	24 2020, end the collection of the MDS data that is necessary to
560	560	25 maintain the current RUG-IV Medicaid payment methodology. The
561	561	26 technical advisory group must consider a revised reimbursement
562	562
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572	572	1 methodology that takes into account transparency,
573	573	2 accountability, actual staffing as reported under the
574	574	3 federally required Payroll Based Journal system, changes to
575	575	4 the minimum wage, adequacy in coverage of the cost of care, and
576	576	5 a quality component that rewards quality improvements.
577	577	6 (l) The Department shall establish per diem add-on
578	578	7 payments to improve the quality of care delivered by
579	579	8 facilities, including:
580	580	9 (1) Incentive payments determined by facility
581	581	10 performance on specified quality measures in an initial
582	582	11 amount of $70,000,000. Nothing in this subsection shall be
583	583	12 construed to limit the quality of care payments in the
584	584	13 aggregate statewide to $70,000,000, and, if quality of
585	585	14 care has improved across nursing facilities, the
586	586	15 Department shall adjust those add-on payments accordingly.
587	587	16 The quality payment methodology described in this
588	588	17 subsection must be used for at least State Fiscal Year
589	589	18 2023. Beginning with the quarter starting July 1, 2023,
590	590	19 the Department may add, remove, or change quality metrics
591	591	20 and make associated changes to the quality payment
592	592	21 methodology as outlined in subparagraph (E). Facilities
593	593	22 designated by the Centers for Medicare and Medicaid
594	594	23 Services as a special focus facility or a hospital-based
595	595	24 nursing home do not qualify for quality payments.
596	596	25 (A) Each quality pool must be distributed by
597	597	26 assigning a quality weighted score for each nursing
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608	608	1 home which is calculated by multiplying the nursing
609	609	2 home's quality base period Medicaid days by the
610	610	3 nursing home's star rating weight in that period.
611	611	4 (B) Star rating weights are assigned based on the
612	612	5 nursing home's star rating for the LTS quality star
613	613	6 rating. As used in this subparagraph, "LTS quality
614	614	7 star rating" means the long-term stay quality rating
615	615	8 for each nursing facility, as assigned by the Centers
616	616	9 for Medicare and Medicaid Services under the Five-Star
617	617	10 Quality Rating System. The rating is a number ranging
618	618	11 from 0 (lowest) to 5 (highest).
619	619	12 (i) Zero-star or one-star rating has a weight
620	620	13 of 0.
621	621	14 (ii) Two-star rating has a weight of 0.75.
622	622	15 (iii) Three-star rating has a weight of 1.5.
623	623	16 (iv) Four-star rating has a weight of 2.5.
624	624	17 (v) Five-star rating has a weight of 3.5.
625	625	18 (C) Each nursing home's quality weight score is
626	626	19 divided by the sum of all quality weight scores for
627	627	20 qualifying nursing homes to determine the proportion
628	628	21 of the quality pool to be paid to the nursing home.
629	629	22 (D) The quality pool is no less than $70,000,000
630	630	23 annually or $17,500,000 per quarter. The Department
631	631	24 shall publish on its website the estimated payments
632	632	25 and the associated weights for each facility 45 days
633	633	26 prior to when the initial payments for the quarter are
634	634
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644	644	1 to be paid. The Department shall assign each facility
645	645	2 the most recent and applicable quarter's STAR value
646	646	3 unless the facility notifies the Department within 15
647	647	4 days of an issue and the facility provides reasonable
648	648	5 evidence demonstrating its timely compliance with
649	649	6 federal data submission requirements for the quarter
650	650	7 of record. If such evidence cannot be provided to the
651	651	8 Department, the STAR rating assigned to the facility
652	652	9 shall be reduced by one from the prior quarter.
653	653	10 (E) The Department shall review quality metrics
654	654	11 used for payment of the quality pool and make
655	655	12 recommendations for any associated changes to the
656	656	13 methodology for distributing quality pool payments in
657	657	14 consultation with associations representing long-term
658	658	15 care providers, consumer advocates, organizations
659	659	16 representing workers of long-term care facilities, and
660	660	17 payors. The Department may establish, by rule, changes
661	661	18 to the methodology for distributing quality pool
662	662	19 payments.
663	663	20 (F) The Department shall disburse quality pool
664	664	21 payments from the Long-Term Care Provider Fund on a
665	665	22 monthly basis in amounts proportional to the total
666	666	23 quality pool payment determined for the quarter.
667	667	24 (G) The Department shall publish any changes in
668	668	25 the methodology for distributing quality pool payments
669	669	26 prior to the beginning of the measurement period or
670	670
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680	680	1 quality base period for any metric added to the
681	681	2 distribution's methodology.
682	682	3 (2) Payments based on CNA tenure, promotion, and CNA
683	683	4 training for the purpose of increasing CNA compensation.
684	684	5 It is the intent of this subsection that payments made in
685	685	6 accordance with this paragraph be directly incorporated
686	686	7 into increased compensation for CNAs. As used in this
687	687	8 paragraph, "CNA" means a certified nursing assistant as
688	688	9 that term is described in Section 3-206 of the Nursing
689	689	10 Home Care Act, Section 3-206 of the ID/DD Community Care
690	690	11 Act, and Section 3-206 of the MC/DD Act. The Department
691	691	12 shall establish, by rule, payments to nursing facilities
692	692	13 equal to Medicaid's share of the tenure wage increments
693	693	14 specified in this paragraph for all reported CNA employee
694	694	15 hours compensated according to a posted schedule
695	695	16 consisting of increments at least as large as those
696	696	17 specified in this paragraph. The increments are as
697	697	18 follows: an additional $1.50 per hour for CNAs with at
698	698	19 least one and less than 2 years' experience plus another
699	699	20 $1 per hour for each additional year of experience up to a
700	700	21 maximum of $6.50 for CNAs with at least 6 years of
701	701	22 experience. For purposes of this paragraph, Medicaid's
702	702	23 share shall be the ratio determined by paid Medicaid bed
703	703	24 days divided by total bed days for the applicable time
704	704	25 period used in the calculation. In addition, and additive
705	705	26 to any tenure increments paid as specified in this
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716	716	1 paragraph, the Department shall establish, by rule,
717	717	2 payments supporting Medicaid's share of the
718	718	3 promotion-based wage increments for CNA employee hours
719	719	4 compensated for that promotion with at least a $1.50
720	720	5 hourly increase. Medicaid's share shall be established as
721	721	6 it is for the tenure increments described in this
722	722	7 paragraph. Qualifying promotions shall be defined by the
723	723	8 Department in rules for an expected 10-15% subset of CNAs
724	724	9 assigned intermediate, specialized, or added roles such as
725	725	10 CNA trainers, CNA scheduling "captains", and CNA
726	726	11 specialists for resident conditions like dementia or
727	727	12 memory care or behavioral health.
728	728	13 (m) The Department shall work with nursing facility
729	729	14 industry representatives to design policies and procedures to
730	730	15 permit facilities to address the integrity of data from
731	731	16 federal reporting sites used by the Department in setting
732	732	17 facility rates.
733	733	18 (Source: P.A. 102-77, eff. 7-9-21; 102-558, eff. 8-20-21;
734	734	19 102-1035, eff. 5-31-22; 102-1118, eff. 1-18-23; 103-102,
735	735	20 Article 40, Section 40-5, eff. 1-1-24; 103-102, Article 50,
736	736	21 Section 50-5, eff. 1-1-24; 103-593, eff. 6-7-24; 103-605, eff.
737	737	22 7-1-24; 10300HB4907enr.)
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